Researcher works toward eradication of hepatitis through education, vaccinations

Hepatitis A, B and C are well-known viral diseases in the U.S., and while they are in the same family of viral diseases, their symptoms and illnesses are different. Vaccines are available for hepatitis A and hepatitis B, of HBV, but none is currently available for hepatitis C, or HCV.

Hepatitis A is acquired mainly through food and can also be spread orally and through sexual transmission. Peter Gulick, a professor of medicine at the College of Osteopathic Medicine, recommends all people be vaccinated for hepatitis A.

“No one is immune,” he said. “There have been outbreaks in restaurants in the past, even here in Lansing.”

Of the three hepatitis diseases, HBV and HCV are the most concerning. Both can cause inflammation of the liver and are the leading causes of liver cancer, according to the National Cancer Institute.

While people can live with HBV or HCV infection for many years without feeling sick, when symptoms eventually do appear, it is often a sign the disease is in advanced stages. Testing is the only way to know if one has either of the diseases and something Gulick recommends for everyone.

To ensure safety from HBV, the vaccine is recommended for infants, children, adolescents and adults. There currently is no cure for HBV, but those living with HBV can receive treatment to delay or reduce their risk of developing liver cancer. Exposure to HBV produces a less than 10% risk for chronic illness and the body does develop immunity, Gulick said, but the person exposed will have a lifelong risk for liver cancer, for which there is no cure. The vaccination for HBV offers protection against this risk.

Limiting exposure, testing and vaccination are key to stopping the spread of the disease. For example, if one person in the family has active HBV — even if they are receiving treatment — other family members should be tested and vaccinated. In addition, those at high risk, such as IV drug users and those with high sexual activities or sexually transmitted infections, should be vaccinated. The vaccine protects all people, and Gulick recommends it for all HIV patients.

HCV, for which there is no vaccine, is transmitted mainly through sexual activity or via blood, including from mother to baby, as well as through intravenous drug use. In fact, HCV is the most common bloodborne disease in the U.S. and is most notably transmitted through IV drug use, Dr. Gulick added.

HCV initially occurred within the baby boomer generation, in large part, due to vaccinations not being sterilized properly in earlier times, he said. That has changed. Today, HCV is the most common hepatitis disease, and the largest occurrence is in young individuals using opioids and IV drugs. Even without a vaccine for HCV, the disease is cured using medications in 98% of cases. And while the disease is curable, people also do get reinfected, Gulick said.

Working to eradicate hepatitis C by 2035

Gulick is part of a team in Michigan that is determined to eradicate HCV by 2035. In 2021, the Michigan Department of Health and Human Services kicked off “We Treat Hep C initiative.” Gulick and the other initiative members are working to educate people, especially primary care doctors, so they are armed with information and equipment to test and treat patients throughout Michigan.

Little testing was being done prior to that, Gulick said, and those who were identified with the disease were sent to specialists. Now, moving this care to primary care physicians presents more opportunity to reach patients. The best time to check for the disease is during a regular doctor’s appointment and helps to get those with HCV on medications as soon as possible, he added.

Gulick champions this message and training through the Center for Rural Health’s Project ECHO® (Extension for Community Healthcare Outcomes), a program that uses videoconferencing to connect groups of physicians and health care providers with specialists at teleECHO clinics to share knowledge and information and to ensure the best care for all people.

Importance of the vaccines and testing

When disease can be prevented by using vaccines it improves the health of communities and protects others from the disease. Gulick suggests speaking with one’s physician about the hepatitis A and B vaccines to determine risk and need. For example, those traveling in areas with high rates of the disease may be a good candidate for the vaccine, as well as those with exposure to drug use and sexual activity.

In addition, he recommends testing for hepatitis, even for those who are unsure if they need it. “Maybe you had a blood transfusion years ago; maybe once you used IV needles,” Gulick said.

For HCV, he suggests anyone at risk be tested. Baby boomers, those who are younger and may be at risk due to IV drugs — even one time use — should be tested.

“They way to cure and prevent the spread of hepatitis is by treating patients,” Gulick said. “One person who is hepatitis C positive can infect 20 other people in one to two years. It’s a big number once you look at math. It is curable, so why not be tested?"

In fact, Gulick said, the drugs used for treatment are very benign and without side effects and the cure rate is 98%.

This story originally appeared on the College of Osteopathic Medicine website.